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Dr Zayed Alsulami Paediatric Clinical Pharmacologist Alkharj Military Hospital, Alkharj, Saudi Arabia 10 – 12 August, 2015

 Medication safety issues are an important aspect of the medication use process in hospitals.  Medication treatment process is a complicated process.  Adherence to medication administration policy steps is an essential.

 Medication administration stage is the last stage in the medication treatment process.  Nurses spend up to 40% of their time administering medications.

 To evaluate how the paediatric nurses adhere to the medication administration policy.  To identify any medication preparation and administration errors.  Also, to identify any contributory factors that may affect the administration process.

 Prospective, direct observational study of paediatric nurses administering medication during their routine practice.  16 steps were evaluated according to the hospital medication administration policy.  Observation process was conducted during weekdays only (Sunday - Thursday), (May – August 2014).

Table 1: Demographic information CharacteristicWard Number of patients90 Age (months), median (range)27.6 ( ) Weight (in kg), median (range)11 ( ) Number of oral drugs (% total)145 (31.7%) Number of IV drugs (% total)193 (42.3%) Number of inhaler drugs (% total)118 (26%) Total number of drugs administered456 (100%)

Table 2: Adherence rate to policy steps Policy stepAdherence rate n = 456Adherence rate % Two nurses Vital signs Drug name Correct drug Correct dosage form Drug dose calculated16135 Expiry date Correct volume Correct IV rate

Table 2: Adherence rate to policy steps (Contd.) Policy stepAdherence rate n = 456Adherence rate % Correct time Correct label Correct route Patient ID Allergy71.6 Admin to the patient Sign to the drug chart

Table 3: Medication administration errors reported Type of errorExampleNo. of errors Drug drops out Nurses drop out few drops of Vancomycin IV dose 19 Wrong time Augmentin IV dose was given 2:18 hr late from prescribed time. 18 Drug given to mothers Domperidone dose was given to the mother without observing at administration 15 Preparation errors Predinosolone tablet was crushed to be prepared as solution, nurses did not add enough quantity of water and also did not mix the content properly. 5 Wrong doses Ceftriaxon IV 300 mg dose was given by nurses instead to 150 mg in drug chart (dose reduced by doctor in drug chart) 2

 Antibacterial drugs were the most common drug class administered and observed (41%).  Out of 16 steps observed, 7 steps were reported to have lower adherence rate.  In total, 63 medication administration errors were detected during the study period.  The incidence error rate is 13.8%  The most common error reported was involved nurses drop out few drops of IV medication before administration, followed by wrong time of administration.

 Risk factors affect nurses’ adherence to policy:  Medication administration policy steps need to be more clarified for the nurses.  Some of the logistics and administrative issues affects on the nurses adherence to the policy.  Shortage in some of instruments that used in drug administration process.  Shortage in the number of paediatric nurses in the ward ( 1 nurse to each 5 patients).

X The medication administration policy and procedure need an urgent revision to be more applicable for nurses in practice. X Paediatric nurses knowledge and skills regarding to medication administration process should be improved.

Questions?

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